Why Bill Gates Fights Diseases Abroad, Not At Home

By ensuring vaccines are invented and distributed, Bill Gates says, his foundation is dramatically reducing the number of childhood deaths in poor countries.

Marie McGrory
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Originally published on April 24, 2014 12:18 pm

This week in Seattle, Bill and Melinda Gates are attending a meeting of the minds.

Five hundred of the world's top innovators in global health have gathered for the Global Health Product Development Forum, an annual event in which scientists, engineers, policymakers and activists work to develop new tools for fighting diseases.

Since the Bill & Melinda Gates Foundation began in 2000, the nonprofit has invested a lot of money in education in the U.S. But even more money has gone toward ending diseases in developing countries. Last year, the foundation dedicated $1.8 billion to eradicate polio worldwide.

NPR's Morning Edition host David Greene recently spoke with Gates about why he and his wife have chosen to focus their efforts abroad and less here at home — and whether he thinks the world is still on track for eradicating polio by 2018.

We note that the Gates Foundation supports NPR programming. And the interview has been edited for length and clarity.

Why have you chosen to invest billions of dollars on diseases that the U.S. eradicated decades ago?

Our view on health is that we have a lot of interventions where we're saving lives for less than $2,000 per life saved.

By making sure new vaccines are invented, making sure they get out to all the kids on the planet, we're taking diarrheal deaths, pneumonia deaths and bringing those down pretty dramatically.

Any country where we can save a life for a few thousand dollars, we'll do it. It turns out the place you can do that — really make dramatic reductions in the number of children who die — is the really poor countries.

One area the foundation focuses on is eradicatingmalaria. Why did you choose that disease?

I was stunned when I found out that malaria, when we got started [in 2000], was killing a million children a year; most of that's in Africa.

Way back in 2000, we gave a $30 million grant, and we became one of the largest funders in the area. It was stunning to me that a problem of such magnitude wasn't getting huge focus. ...

For Africa to move forward, you've really got to get rid of malaria.

Nobel Prizes have been given for work on malaria. Governments and foundations have spent a flood of money on it. But the disease has persisted. Why do you think this is the moment when you can make a difference with malaria?

Those Nobel Prizes were given a long time ago. The thing that's magical now is that we're able to look at the malaria genetics and understand how it's spreading. ...

It's fair to say that there have been failures in the past. The year I was born, 1955, the first big disease-eradication program in the world was declared for malaria. After about a decade of work, they realized that at least in the tropical areas, they did not have the tools to get it done.

We're going to have to be a lot smarter this time.

We're able to model the disease dynamics in a way that wasn't possible before. We actually have a vaccine [now]. It's not a 100-percent-effective vaccine. But that looks like it will be a very helpful tool.

Do you think there will ever be moment when you might start thinking that maybe money would be better spent on something outside health or vaccines, such as infrastructure?

I don't think that's likely to happen. We want to be realistic. [But] people do care a lot about [malaria]. They see their children dying. They see the effects of cerebral malaria even on kids that survive.

So I don't think this is one where we'll run into much resistance, too much apathy. This is a big killer.

Development is a series of things. If you could only pick one thing, I think you would pick health because it's so catalytic.

But then education, good governance, infrastructure — all of those things are part of the magic things that have allowed countries like China, Brazil, Thailand, Mexico to become middle-income.

So now we can focus on the remaining countries, the low-income countries, and have a goal that within 20 years, the number of people living in extreme poverty could get close to zero.

The foundation also works on wiping outpolio. The goal is to finish the job by 2018. Do you think that's still realistic after recentsetbacks?

[Polio eradication] is our top priority. And things are looking pretty good in Nigeria. We've had only one case this year, which is way down from last year.

We have an outbreak that started in Syria that has spread to some surrounding countries. We think we'll be able to deal with that outbreak.

In Pakistan, we still have an area that the Taliban is not letting in vaccinators; and in fact, violence against vaccinators continues there. ...

We're still very committed to the eradication; 2018 still seems achievable. But we're going to have to get a bit of political change in Pakistan, and we're going to have to continue to do very good work in Nigeria.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

This week in Seattle, Bill and Melinda Gates are pulling together a meeting of the minds. Five hundred of the world's top global health innovators have gathered for the Global Health Product Development Forum. It's an annual event for donors and partners of the Bill and Melinda Gates Foundation and we're working to eradicate the world's deadliest diseases.

DAVID GREENE, HOST:

We should note that the Gates Foundation also supports NPR programming, but today we are talking about ending polio and malaria. We spoke to Bill Gates from the conference in Seattle. He recalled what drew him to this work in the first place.

BILL GATES: Well, I was stunned when I found out that malaria, when we got started, was killing a million children a year. It's one of the primary things that kills young children. Most of that's in Africa. And we, way back in 2000, gave a $30 million grant and became one of the largest funders in the area, which was stunning to me that a problem of such magnitude wasn't getting huge focus.

It's a terrible disease. And so for Africa to move forward, you've really got to get rid of malaria.

GREENE: I just want to think about some of the facts about this disease. I mean more than 200 million cases, 200 million in 2012. In Africa, a child is dying every minute from malaria. It's the leading cause of death in many developing countries. I mean there have been Noble Prizes given for work on this disease. There have been governments and foundations spending a lot of time and money, but it's just persisted.

I mean why do you think that this is the moment where you can make a difference here?

GATES: Yeah, those Nobel Prizes were given a long time ago. The thing that's magical now is that we're able to look at the malaria genetics and understand how it's spreading. And so, you know, how do you repel the mosquitoes, we understand. And the global community's really come together. Now, it's fair to say that, you know, there have been failures in the past.

The year I was born, 1955, the first big disease-eradication program in the world was declared for malaria. And after about a decade's work, they realized that at least in the tropical areas they did not have the tools to get it done. Then they tried again and failed again. So you know, we're going to have to be a lot smarter this time.

We're able to model the disease dynamics in a way that wasn't possible before. We actually have a vaccine. It's not a 100-percent-effective vaccine. But that looks like it will be a very helpful tool. And so I'd say it's the depth of understanding and the commitment is why I'm optimistic this time.

GREENE: Richer countries have been able to eliminate this disease and many poor countries have not.

GATES: Yeah, these countries are tough. They're mostly near the equator and so they're getting malaria on a year-round basis. The thing we have in the U.S. where we had malaria was that during the winter we had very few people who were carrying the malaria parasite. In subsequent winters you had less and less people carrying it over until eventually had zero.

But we don't have winters around the equator, so it requires far better tools than it required for the United States.

GREENE: But might there be a moment when you have to face a reality that in terms of allocating resources, you know, money might be better spent by helping countries with income growth, helping countries develop better infrastructure because you just face a reality that some of these developing countries, you know, there might suspicions about government, they're not going to trust government officials to deliver, you know, future vaccines?

GATES: I don't think that's likely to happen. You know, we want to be realistic. People do care a lot about this disease. They see their children dying. They see the effects of cerebral malaria on even kids who survive. So I don't think this is one where we'll run into too much resistance, too much apathy. You know, this is a big killer.

You know, development is a series of things. If you could only pick one thing, I think you would pick health because it's so catalytic. But then education, good governance, infrastructure, all of those things are part of the magic things that have allowed countries like China, Brazil, Thailand, Mexico to become middle-income.

And so now we can focus on the remaining countries, the low-income countries, and you know, have a goal that within 20 years the number of people living in extreme poverty could get close to zero.

GREENE: Last year, you were on one of our other programs, ALL THINGS CONSIDERED, talking about polio. Your foundation dedicated $1.8 billion to fight that disease. Last year there were only 400 cases in the world, but you made an argument that if you can wipe out those last cases, you would save the world billions of dollars over time because you'd no longer have to vaccinate anybody.

A year on now, how close are you?

GATES: Well, this is our top priority. And things are looking pretty good in Nigeria. We've had only one case this year, which is way down from last year. We have an outbreak that started in Syria that has spread to some surrounding countries. We think we'll be able to deal with that outbreak. In Pakistan we still have an area that the Taliban is not letting vaccinators in. And in fact there's continued to be violence against vaccinators.

The government there has this as something that's important so, you know, we think that could turn around. But we're certainly involved in talking to the army and to, you know, Imran Khan, to the prime minister. It's fantastic they're willing to make polio a priority and talk about how they're getting the visibility, pulling people together.

And so, you know, we're still very committed to the eradication - you know, 2018 still seems achievable. But we're going to have to get a bit of a political change in Pakistan and we're going to have to continue to do very good work in Nigeria.

GREENE: Bill Gates, your foundation spends a lot of money on education in the United States, but a huge amount of your money is spent trying to fight infectious disease outside of this country. Why so much focus abroad and less at home?

GATES: Well, our view on health is that we have a lot of interventions where we're saving lives for less than $2,000 per life saved. By making sure new vaccines are invented, making sure they get out to all the kids on the planet, we're taking diarrheal deaths, pneumonia deaths, and bringing those down pretty dramatically.

And any country where we can save a life for a few thousand dollars, we'll do it. It turns out that the place you can do that and really make dramatic reductions in the number of children who die is in the very poor countries.

GREENE: Bill Gates is the founder of Microsoft and the co-chair of the Bill and Melinda Gates Foundation. Thanks so much for your time.